2265 North Clybourn Avenue    Chicago, IL 60614    P: 773.296.6700     F: 773.296.1131

Empty Nose Syndrome

Never heard of it? Neither had I. Sounded more like a Sherlock Holmes story than a “condition” somebody could have. But there it was, written by the patient himself in the Reason For Visit section of our intake form. Before he actually walked into the examining room, I made a quick obeisance before my PC, fingers flying across the keys, summoning the all-powerful Wiki gods for some quick education on empty nose syndrome.

“Aha!” I muttered to myself. “So someone finally gave a name to that piece of surgical butchery.” I’d seen a couple of patients with it in the distant past, before it got its new moniker, and knew there wasn’t much to offer anyone with an empty nose except empathy.

The main symptom of empty nose syndrome is a paradoxical one. Despite its name, you have the constant sense that your nose is stuffed up and you can’t breathe. One click beyond Wiki provided some genuinely depressing news: there even exists an empty nose syndrome association that provides updates on the progress of various treatments.

When I was first in training as a fledgling internist, one of my professors, crusty and cheerful as a barnacle, cautioned us never to be in thrall of surgery. If we were doing our jobs right, we kept people out of hospitals and especially out of operating rooms except when strictly needed.

“There’s far too much unnecessary surgery out there,” he snarled (crustily). “And surgeons are rewarded with more money than is good for ‘em, all to do more surgery, not less.” And then, with withering contempt, he added, “The surgeon’s brain is incapable of patience. Surgeons maintain their own myth that ‘surgery cures’ and actually believe a scalpel can fix anything.”

Iatrogenic: illness caused by treatment
In medicine’s perpetually obscure vocabulary, we use the term “iatrogenic” for any illness caused by medical or surgical treatment. A physician’s voice drops an entire octave when he’s forced to say the word aloud, especially if it happens to be over a corpse. Empty nose syndrome is the ne plus ultra of iatrogenic debacles, though there are thousands of other iatrogenic disasters. On the brighter side, at least you don’t die from it.

Empty nose syndrome is the result of an overenthusiastic surgeon removing one or more bones in your nose called the turbinates. These are a pretty complex network of bones and blood vessels whose purpose is to warm, moisten, and filter the air you inhale. You become aware of your turbinates when you’ve got a cold. Their moist surfaces swell and as a result you get a stuffy nose. As delicate as Irish Belleek, the turbinates break easily, an occupational hazard among professional boxers, hockey players, and yours truly, taking an over-the-handlebar header on my bicycle. I needed minor turbinate surgery (and new teeth), but other than extreme cases all in all it’s probably best to leave your turbinates alone.

People with empty nose syndrome began appearing as a consequence of some articles in the medical literature that contained the same absence of logic involved in doing prefrontal lobotomies for mental illness. Overly aggressive ear-nose-and-throat (ENT) surgeons, struggling with the twin burdens of BMW payments and children at Yale, hit a gold mine when someone linked the then-mysterious chronic fatigue syndrome to obstructive sleep apnea, in which a blocked, weak, or narrowed airway causes periods of non-breathing during sleep.

The connection has since been disproven, but to this day if you complain to your doc about being tired frequently, sooner or later you’ll find yourself spending some serious money in a sleep lab.

Sleep apnea has been a gold mine for the ENT boys. The non-surgical treatment for sleep apnea, a CPAP (continuous positive airway pressure) machine wheezily forcing air down your throat, is, for many users, about as pleasant as one of the toys from the Spanish Inquisition. If a CPAP fails to resolve nighttime breathing problems, which is common, your second option is (you guessed it) surgery. Don’t let it surprise you that many successful ENT surgeons have financial interests in sleep labs and are more than willing to sell you a CPAP machine if they can’t get you on the operating table.

A nasal crime
For some years now, ENT surgeons have been performing a variety of procedures for sleep apnea and I will acknowledge they’ve gotten better at it. But the hundreds of people in the empty nose support group are in the before-we-got-good-at-this group, victims of what one surgical journal described as “a nasal crime.” Empty nose victims often also had surgery for chronic sinusitis and deviated nasal septum, two conditions where the indications for surgical intervention are marginal at best.

The most disturbing case of sleep apnea butchery I ever saw was some years ago and not in an empty nose syndrome patient. A young man I’ll call David, in his twenties with chronic fatigue syndrome, had read about the sleep apnea connection, knew he had large tonsils (a possible cause of obstructive sleep apnea), and made his own appointment with an eminent ENT physician who was head of the department at a major university hospital. David underwent the recommended sleep study and afterward met with the surgeon, who looked in his throat, glanced at the report, and scheduled him for surgery the next day.

When he awakened, David discovered that swallowing food had become problematic. The surgeon had not only removed his tonsils, but also his uvula and part of his soft palate. Your uvula is that little piece of hanging flesh at the back of your throat, and it’s attached to your soft palate. Now missing these parts, David found that if he didn’t swallow slowly and carefully, part of whatever was in his mouth went upward into the back of his nose. He’d been working with therapists to correct this. Of course, his chronic fatigue issues remained unchanged.

But the real jaw-dropping moment occurred when I was going over the stack of medical records David handed me. Buried in the files were the results of his original sleep study. At the bottom of the page was written, “Conclusion: No evidence of obstructive sleep apnea.”

Truly, we were both stunned. I said, “You know, I rarely recommend filing a malpractice suit, but this is criminal.” David said he’d think about it, but in speaking to him a couple years later he told me he’d never pursued it. “I was too ashamed. I’d been really…dumb, careless, I should have known better. I just wanted to leave it behind me.”

Since the Middle Ages, surgeons and barbers have been lumped into a single profession, the red stripes of the barber pole symbolic of blood-soaked rags. This has always struck me as unfair to barbers.

When an enthusiastic barber clips away too much hair, you can count on it to eventually grow back. With surgery, you’re stuck.

Stay well,
David Edelberg, MD

Leave a Comment


  1. Pat Stanley says:

    Your articles are so good. I imagine you have thought about compiling them into a book ? I would buy it….even though I already save the good ones.!

  2. Wendy says:

    Actually there is an alternative to cpap – it’s a mouth piece (looks not far from a mouth guard used by football players) that is molded by a dentist that positions your jaw to prevent sleep apnea. But it takes getting used to and I have no idea how much the cost with dentist totals and what insurance pays. You can get a cheap one online ($30 – 50), mold it yourself and try it out [it takes some time for your jaw to get used to it]. While I don’t regret my sinus surgery – I spent probably 6 months a year (for 5+ years) with sinus infections, calling after a week of a fever for an antibiotic (which usually took 2 courses) and the infection sometimes migrated to my asthma lungs, I am probably the exception. [Despite daily neti pot use and decongestant during surgery they still found gunk deep in my sinuses because it had no where to drain.] Did fixing my deviated septum help? With a narrow English nose maybe, but not sure on that. (Cosmetically it looked enough the same my mother never noticed, I think it looked slightly better before.)

  3. liz says:

    Oh my god! Not only do I continually love your attitude but I also love the way you write. Thank you for keeping me informed and also entertained.

  4. Jean says:

    As mentioned by Wendy there is an alternative to CPAP machines that work for some. I have been using an oral “appliance” (also known as as mandibular advancement device or splint)and it is helpful.

  5. Maureen says:

    I knew someone who had this as a side effect of sinus surgery! It turned his life in to a living Hell. He couldn’t sleep at all at night because he would feel like he wasn’t able to breathe–over & over & over. I would implore anyone to exhaust all options like acupuncture, herbal medicine, chiro, etc. before submitting to sinus surgery! Maureen McLaughlin, LAc

  6. Tom says:

    Can you help with diagnosed ENS from over-aggressive septoplasty?

Join our Newsletter

Get health recommendations, delicious and time-saving recipes, medical news, supplement reviews, birthday discounts, and more!

BIRTHDAY

Health Tips

Dr. Edelberg’s Health Tips contain concise bits of advice, medical news, nutritional supplement and pharmaceutical updates, and stress relief ideas. With every Health Tip, you’ll also receive an easy, delicious, and healthful recipe.

When you sign up to receive Health Tips, you can look forward to Dr. Edelberg’s smart and very current observations arriving in your in-box weekly. They’re packed with helpful information and are often slightly irreverent. One of the most common responses to the tips is “I wish my doctor talked to me like this!”

Quick Connect

Get One Click Access to our

patient-portal

The Knowledge Base

Patient education is an integral part of our practice. Here you will find a comprehensive collection of staff articles, descriptions of therapies and nutritional supplements, information addressing your health concerns, and the latest research on nutritional supplements and alternative therapies.

Join our Newsletter

Get health recommendations, recipes, medical news, supplement reviews, birthday discounts, and more!

Upcoming Workshops

**Who’s Ready to Eat Fat? An Introduction to the Ketogenic Diet
Tuesday November 13, 2018, 6-7:30 PM
Marla Feingold, CCN, CNS, LDN
Fee: $65 (includes take home materials)

Want to reduce hunger, burn fat for fuel, stabilize blood sugar, increase memory, cognition, energy, reduce headaches, decrease inflammation, prevent heart disease?  Discover how a Ketogenic Diet can optimize your health.

Space is limited and registration is required.
Please register online.
Call the Center for additional information at (773) 296-6700
More>>

 

***Healing Touch for Focus, Creativity, and Stress Management
Thursday, December 6, 2018, 5:45-7:30
Katie Oberlin, HTCP/I
Healing Touch Certified Practitioner/Instructor
Fee: $55.00 (includes take-home materials)

Are you feeling overwhelmed and stressed at the end of the year? Want to find a way to feel less scattered and more focused? In this workshop, you will learn how to use energy healing to feel more centered and grounded so you can bring more clarity and creativity to your life and work.

Space is limited and registration is required.
Please register online.
Call the Center for additional information at (773) 296-6700
More>>

 

***WholeHealth for Winter Digestion
Saturday December 1, 2018, 10:30am-12:30pm
An Integrative Workshop with Yoga Therapist Renee Zambo, Dietitian Olivia Wagner, and Occupational Therapist Valarie McConville
Fee: $75.00 (includes take home materials and snacks)

Do you suffer from a sluggish digestive system, constipation, and/or bloating? Does it feel like those symptoms get worse as we head toward the holidays and winter season?  Are you looking for ways to optimize your digestion?  

Join us for two valuable hours of digestive health and cleansing!

Space is limited and registration is required.
Please register online.
Call the Center for additional information at (773) 296-6700
More>>

Recent Health Tips

  • How To Get Off Statins

    Getting off statins is easy. Stop swallowing the pill. If you’re not in a potentially high-risk group (as described below) and your doc prescribed a statin to get your cholesterol down a bit, you won’t have a heart attack or a stroke that day or week or probably that decade. There’s no “statin withdrawal” and you weren’t born with a statin deficiency. In fact, many Read More

  • Pushing Your Wellness Exam Into The 21st Century

    Patients ask me, “What about those wellness exams my health insurance company says I’m entitled to every year at no cost?” Bad news. Let’s review one of life’s basic rules: you get what you pay for. What you receive during your short wellness visit (what many consider a sacrosanct ritual that boosts longevity) is little more than a quick look at the obvious. Your weight, Read More

  • Empty Nose Syndrome

    Never heard of it? Neither had I. Sounded more like a Sherlock Holmes story than a “condition” somebody could have. But there it was, written by the patient himself in the Reason For Visit section of our intake form. Before he actually walked into the examining room, I made a quick obeisance before my PC, fingers flying across the keys, summoning the all-powerful Wiki gods Read More

Apothecary Sales All Week Long!

*Monday, Tuesday, and Wednesday – All in-store purchases are 15% off

*Black Friday (9:00 AM – 4:00 PM) – All in-store purchases are 20% off

*Black Friday (9:00 AM – 4:00 PM) – All phone order purchases are 15% off

*Small Business Saturday® (9:00 AM – 3:00 PM) – All in-store purchases are 20% off

*Cyber Monday (24 hours) – All on-line purchases are 20% off
(with discount coupon code to be released soon)

Join us for big savings all week long.

Happy Thanksgiving!

<<HOLIDAY HOURS>>
Monday, November 19; 8:30am – 6:00pm
Tuesday, November 20; 8:30am – 7:00pm
Wednesday, November 21; 8:30am–6:00pm
Thursday, November 22; closed
Friday, November 23; 9am – 4pm
Saturday, November 24; 9am – 3pm

 

Not valid with any other discounts, offers, promotions, or special orders.